Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea.
Institute of New Frontier research Team, Hallym University, Chuncheon, South Korea.
Eur Stroke J. 2023 Mar;8(1):208-214. doi: 10.1177/23969873221144814. Epub 2022 Dec 13.
We evaluated the effects of prior antiplatelet use (APU) on futile reperfusion (FR) after endovascular treatment (EVT) in acute ischemic stroke.
We consecutively collected data of 9369 patients with acute ischemic stroke from four university-affiliated multicenter registry databases over 92 months. We enrolled 528 patients with acute stroke receiving EVT. Among them, we defined FR in subjects as a 3-month modified Rankin Scale score of >2 despite successful reperfusion after EVT. We classified patients into two groups: prior APU and no prior APU. We used propensity score matching (PSM) to overcome the imbalance in multiple covariates between the two groups. After PSM, we compared the baseline characteristics between the two groups and performed multivariate analysis to determine whether prior APU affected FR and other stroke outcomes.
The overall FR rate in the present study was 54.2%. In the PSM cohort, the FR was lower in the prior APU group than that in the no prior APU group (66.2% vs 41.5%, < 0.001). In the multivariate analysis using the PSM cohort, prior APU significantly reduced the risk of FR (odds ratio (OR), 0.32; 95% confidence interval (CI), 0.18-0.55; = 0.001) and stroke progression (OR, 0.38; 95% CI, 0.15-0.93; = 0.03). Prior APU was not associated with symptomatic hemorrhagic transformation in this study.
Prior APU potentially reduced FR and stroke progression. Further, prior APU was not associated with symptomatic hemorrhagic transformation in patients receiving EVT. APU pretreatment can be a modifiable predictor of FR in clinical practice.
我们评估了血管内治疗（EVT）后抗血小板治疗（APU）对无效再灌注（FR）的影响。
我们连续收集了 92 个月内来自四个大学附属医院多中心登记数据库的 9369 例急性缺血性卒中患者的数据。我们纳入了 528 例接受 EVT 的急性卒中患者。其中，我们将 EVT 后成功再灌注但 3 个月改良 Rankin 量表评分仍>2 的患者定义为 FR。我们将患者分为两组：APU 组和无 APU 组。我们使用倾向评分匹配（PSM）来克服两组间多个协变量的不平衡。PSM 后，我们比较了两组间的基线特征，并进行多变量分析以确定 APU 是否影响 FR 和其他卒中结局。
本研究的整体 FR 发生率为 54.2%。在 PSM 队列中，APU 组的 FR 低于无 APU 组（66.2%比 41.5%，<0.001）。在 PSM 队列的多变量分析中，APU 显著降低了 FR 的风险（比值比（OR），0.32；95%置信区间（CI），0.18-0.55；=0.001）和卒中进展（OR，0.38；95%CI，0.15-0.93；=0.03）。在本研究中，APU 与症状性出血转化无关。
APU 可能降低 FR 和卒中进展。此外，APU 与 EVT 患者的症状性出血转化无关。APU 预处理可能是临床实践中 FR 的可改变预测因素。
